Addiction: A New Treatment Paradigm

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Complementary and Integrative Medicine in the Treatment of Addiction

There is now widespread acknowledgement that a more comprehensive and integrated model of treatment is needed in the mounting problem of addiction worldwide, and that the standard care has been largely a failure. Assumptions that abstinence would resolve the variety of problems in the addiction syndrome, and the neurocognitive decline and pathology, are proven false. Assumptions that drug substitution with pharmaceuticals that were themselves addictive would be a "cure", and not just add to the perpetuation of the addiction pathophysiology, have been proven to be false. A recognition that the pathology of addiction is intrinsic to a cycle of dysfunction in the individual, and not just a problem of a particular substance, food or activity, and indeed creates neurocognitive decline as well as other health problems, is becoming well known. It is becoming obvious that a more comprehensive and holistic treatment protocol is needed in the care of patients with an addiction syndrome, not just abstinence or substitution.

Polypharmacy has been now highly promoted, but most of the drugs used in this treatment have been shown to be abused, and have evidence of problems with rebound and withdrawal and addiction themselves. To fully address the disease of addiction syndrome, a broader integrative treatment protocol is sorely needed. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) could play an important role as an adjunct to direct care, and a lot of scientific evidence now supports the many ways that CIM/TCM could help in treatment. More importantly, now that we recognize that the addiction syndrome is not just a sudden demonic possession caused by a particular substance in individuals that are genetically doomed to be addicts, but a gradually developing cycle of dysfunctions in the brain, early treatment with safe and effective CIM/TCM, as well as targeted cognitive and behavioral psychotherapy could prevent a serous progression in addiction. These treatments can be best utilized as short courses of treatment, with a more proactive patient approach and persistent therapeutic protocols continued at home, both with herbal and nutrient medicine, as well as cognitive and behavioral habits. Such an approach could greatly decrease the incidence of serious addiction and the eventual problems with family, friends, work and finances that are seen in addiction.

While auricular acupuncture models have been used and touted for over 2 decades for the cessation of smoking addiction, as well as other drug addictions, a number of small studies have also noted that the effects failed to significantly outperform placebo acupuncture, although the use of a so-called 'placebo' needle stimulation is of course controversial as a comparison. These ear acupuncture clinics were so successful that many were mandated in prisons, and provided in many cities by public health organizations. Whether these few studies discounting auricular acupuncture were designed with problems for the acupuncture protocol, like many acupuncture studies in the past, now highly criticized by medical experts around the world, is a question of merit. Often, the chosen 'placebo' acupuncture performs well in these studies, as does the so-called real acupuncture. The bottom line today is that even the U.S. military touts and supports auricular acupuncture for the treatment of chronic pain, post-traumatic stress syndrome, and drug addiction. A comprehensive meta-review of these now numerous studies of ear acupuncture protocols for smoking cessation by the esteemed Cochrane Database showed that there is still no definite proof that this protocol alone does not work, but that perhaps a more comprehensive protocol should be adopted, combining the ear acupuncture with standard acupuncture and electroacupuncture, as well as simple herbal and nutrient medicine, and of course, cognitive and behavioral techniques. Such Complementary and Integrative Medicine (CIM/TCM) protocol is recognized as safe and inexpensive, and good for you, and can be integrated with standard protocol as well, but is still not encouraged in standard medicine, despite the obvious need to provide better therapy, and safer therapy, for smoking cessation. Nevertheless, we have moved on from this simple model of acupuncture treatment in adjunct care for addiction, and significant scientific study has elucidated better treatment protocols for the cure of drug addiction, and continues to research these refined protocols. Some of the studies are provided in the section of this article entitled Additional Information with links to the study summaries. These studied adjunct treatment protocols in CIM/TCM are specific and measurable in their effects. These studies show clearly that specific acupuncture protocols are effective during the various stages of craving, binge and withdrawal. To treat effectively, an intelligent individualized treatment protocol that incorporates proven herbal and nutrient medicines, as well as cognitive and behavioral strategies, needs to be utilized. This holistic strategy does not require expensive stays in addiction treatment centers.

Many studies around that world now verify with both brain imaging and studies of the chemical and biological changes in the brain and blood circulation the specific effects of acupuncture and electroacupuncture on specific areas of the brain. While advocates of polypharmacy in addiction care state that they must use opiate substitutes to treat opiate addiction because the withdrawal of chronic exogenous opiates leaves the patient deficient in endogenous opiates and suffering from chronic pain sensation, but it has been acknowledged for decades that acupuncture and electroacupuncture stimulation create strong production of endogenous opioids, as well as strong activation of opioid receptors. Since acupuncture needle stimulation at trigger points merely elicits normal homeostatic responses in the body, these effects are normalizing and modulating, not forcing or replacing a biochemical change. In this sense, acupuncture and electroacupuncture are thus safe, potentially effective, and restorative, with no adverse effects. The integration of acupuncture stimulation with tapering use of methadone or buprenorpine and limited us of naloxone would thus seem more sensible than just providing these opiate substitutions to addicts with chronic use. The utilization of TCM analgesia, stress reduction and restorative medicine in this quick transition to a true drug-free state would also seem sensible, but it is not utilized.

In Asia, research into integration of CIM/TCM protocols such as acupuncture, herbal and nutrient medicine, and mind-body protocols such as Qi Gong, Tai Chi etc. into the addiction treatment is blossoming. Much clinical research and application has led to an effective protocol in Chinese hospitals, pioneered by Dr. Han Jisheng of Peking University, in Beijing. By 2013, his refined and studied protocol utilizes a basic set of points with alternating 2/100 Hz electric stimulation to achieve various physiological and biochemical goals. The points used are HT7, LI4, SI3, PC4, ST36 and SJ9, with the addition of ear points Shenmen and Brainstem. With individual cases, and different types of addiction, this protocol can be adjusted. To increase the benefits in the treatment of addiction, though, the TCM physician will usually combine this therapy with herbal and nutrient medicine, and provide time and advice for the patient to explore positive cognitive and behavioral changes to aid in the cure of addiction. We see from study in recent years that deep tissue physiotherapy can also provide much measurable benefit, and a separate article on this website documents this. Of course, at the heart of this more comprehensive therapeutic protocol in addiction is the ability of the patient to understand their problem and what needs to be accomplished, objectively. A proactive approach is perhaps the most important part of addiction treatment, and cognitive and behavior therapy and patient education is the key to this proactive approach. Cessation of addiction cannot be forced on an individual in the long term. The measure of success of CIM/TCM adjunct care is not a cessation of craving and addiction by a short course of electroacupuncture alone, but the measurable benefits of this protocol in a more holistic and comprehensive treatment strategy. This therapy is not an "alternative" to standard treatment, but should be integrated into care as a complement. To achieve this we must get past the strong health industry bias and decades of opposition to CIM/TCM.

In 2015, research at the Daigu Haany University College of Korean Medicine, in South Korea, showed that electroacupuncture stimulation significantly modulated cFos expression in the ventral tegmental area and nucleus accumbens to reduce craving for morphine in laboratory animals (PMID: 26276453). The cycle of addiction pathology involves 3 stages, the binge, withdrawal and craving stages, and appropriate therapy must address these stages during treatment. The points studied for the binge stage of the addiction cycle were SI5 and HT7. A 2015 study in China found that stimulation at the points UB23 and ST36 with either electroacupuncture and/or manual stimulation improved the function in the amygdala in laboratory animals during morphine withdrawal (PMID: 26237972). Studies at the AOMA Graduate School of Integrative Medicine in Austin, Texas have also shown benefits in controlling withdrawal anxiety with scalp electroacupuncture at the points Yintang and DU23/24, and the points Taiyang and GB8/9, affecting the amydala (PMID: 25105075). This protocol could be used during the withdrawal and craving stages of the addiction cycle. Studies in 2015 at the Kyung Hee University College of Korean Medicine, in Seoul, South Korea, using fMRI on human subjects, identified the points PC6 and HT7 to decrease excitability in the prefrontal cortex and hippocampus, and improve function in the insula and parietal cortex (PMID: 26211895). Other studies have found that the points GB34 and ST36 significantly affect the prefrontal cortex and hippocampus as well. This protocol could also be used in the craving stage of addiction. Such research is greatly helping to define an optimum acupuncture protocol in integrative treatment for addiction. Of course, a comprehensive treatment strategy, involving short courses of acupuncture and electroacupuncture, specific herbal and nutrient medicine, and cognitive and behavioral therapy, must be used to achieve the best outcomes.

Since the mechanisms of nicotine and amphetamine stimulation involve stimulation of dopamine release in key centers of the brain, the use of dopaminergic herbs during withdrawal from nicotine may be helpful in the withdrawal phase of drug addiction as well, to offset the drop-off of dopamine production as the drug is tapered. The sudden lack of dopamine stimulation may account for a number of the symptoms of withdrawal. The USDA Dr. Duke's Phytochemical and Ethnobotanical Databases list a number of dopaminergic herbs and foods, including Uncaria tomentosa (Cat's Claw, or Gou teng), Alisma plantago (Ze xie), and oats, soy, barley, Mate leaf tea, lentil, alfalfa, rice, avocado, pea, cacao, wheat, and fenugreek. Of course, some of these foods will have only a small dopaminergic activity, but dietary sources could be valuable when combined with stronger herbal extracts. Dopaminergic chemicals are also found in a number of Chinese and Western herbs as well, such as Mucuna pruriens and Muira puama, and the professional herbalist may be able to utilize specific herbs or formulas to achieve this goal. Such common herbs as St. John's Wort (Hypericum perforatum) and Kava have long been noted in studies to act as potent reuptake inhibitors of dopamine, serotonin and norepinephrine, and may be applicable to therapy. The persistent use of dopaminergic herbs and foods is needed to effect a change in dopamine receptor balance and expression.

Dopamine is commonly associated with the reward system in the brain. Normally, a variety of activities stimulates increased dopamine release, including laughing, sex, good food, drugs, and aggression. Amphetamines and cocaine also are found to increase dopamine release in the mesolimbic pathway, but also inhibit the re-uptake of dopamine. Dopamine is thought to be balanced with serotonin in the brain as well, and deficient bioavailability of serotonin is well known to be associated with the mechanisms of mood depression and anxiety. Stimulation of dopamine is thought to be crucial to alleviating the nicotine withdrawal symptoms. GABA systems, a primary inhibitory neurotransmitter system in the brain, and mood modulator, are thought to significantly modulate dopaminergic transmissions at the level of the VTA and nucleus accumbens, and support of the GABA system may also be helpful to moderate the withdrawal effects. Studies have demonstrated in the laboratory how GABA agonists decrease nicotine-induced dopamine increases in key nuclei of the brain. Use of serotonin precursor 5HTP and the combination of high dose L-glutamine, P5P and inositol hexacotinate to provide improved bioavailability of GABA and serotonin during the withdrawal process may be helpful in the protocol as well.

Of course, there are well studied adverse health effects seen in various syndromes of addiction, and utilizing Complementary Medicine to not only address the cessation of use of addictive substances, but also to improve the healthy homeostasis of the central nervous system, to calm anxiety, to detoxify, and to restore liver health and function, is important. As research into addiction reveals the risks of comorbid diseases associated with various addictions, such as cancer and fatty liver disease, as well as neurodegenerative conditions and psychological disease, we see the potential of integrating Complementary Medicine as an individualized and holistic treatment protocol as a key to addressing all of these issues surrounding addiction, as well as clearing the damage resulting from chronic addiction. The attitude that acupuncture alone is only useful to help stop the consumption of the addictive substance in Complementary Medicine is too simplistic. The real benefits of Complementary Medicine in addiction are varied and perhaps even more important than even stopping the consumption of the substance of concern. If these health problems are addressed holistically, improved health, disease prevention, and eventually, the cessation of the addictive cycle, will result. If you fear that a syndrome of abuse and addiction is developing, you can see from the research presented in this article that Complementary Medicine may provide you the means to prevent this substance or food abuse from creating a strong addiction physiology, or prevent the potential damage to your health that will result from substance abuse or food addiction.

In 2016, researchers at the Centre for Addiction and Mental Health, and the Sleep Research Laboratory, associated with the University of Toronto, Ontario, Canada, published a study that showed that acupuncture has been proven effective for insomnia and anxiety, and in a small human clinical trial was shown to increase nocturnal melatonin secretion as one mechanism of measurable benefit. These experts noted that insomnia and anxiety contribute heavily to the addiction cycle, and that integrating acupuncture could help greatly in the holistic treatment protocol. To see this study, just click here: http://www.sunshineih.com/Health/wp-content/uploads/2010/11/Nocturnal-Melatonin.pdf . This is obviously just one of the many ways that short courses of acupuncture, herbal and nutrient medicine, physiotherapy and counseling could help in this area of addiction. Hopefully, more experts in the field will encourage such utilization of CIM/TCM.

A knowledgeable and thoughtful TCM physician will be able to guide this therapy described above appropriately to achieve the best results in adjunct integrative therapy as the patient goes through the withdrawal and craving phases of addiction. A number of anxiolytic herbs and supporting herbal formulas can be used to modulate neuroendocrine activity to ease the emotional states that are expected as these phases are experienced. If the addiction is strong, the patient may relapse, as is often the case, but improved health and a positive attitude will allow him or her to understand that this is just a process and must be dealt with calmly and objectively, not giving in to a loss of hope in the outcome or despair and return to fully giving in to the urge to binge heavily.

A Policy of Prevention in Addiction

While past policies in drug prevention kept it simple, such as the "Just Say No" campaign of the Reagan era, these tactics just led to an ever expanding percentage of the population both using drugs and becoming addicted. A more sensible approach is emerging with the expanded biomedical definition of addiction, and this can be applied broadly to help people prevent the disease of addiction from taking root. Both improved public education and a holistic protocol to stop the brain from changing in the dopaminergic pathway from the midbrain to the frontal cortex can potentially avert serious addictive syndromes. In addition, the Health Care Affordability Act provides for increased access to care in the prevention of drug relapse in addiction, emphasizing increased outpatient services instead of the drug rehab clinics we have now. Hopefully, as Mayor Michael Bloomberg of New York is urging, the U.S. and the world will also stop the food industry from promoting addictive foods and food additives as well. Addictive food may indeed by a "gateway" to future addiction.

As the treatment and prevention of addiction is established in mainstream medicine, and removed from its place as a specialty medicine that waits until patients are suffering from extreme addiction, then sequesters them into a stigmatized world of addicts, we must adopt a broader model of care and prevention, seriously educating the public to the science of addiction and helping people to avoid serious disease. By both admitting that addiction is a process that occurs on many levels, with many substances and behaviors, and integrating a broader approach to restoration of healthy homeostasis in the brain, we can prevent most cases of addiction proceeding to the hopeless stage. Integration of Complementary Medicine may play a significant role in this health arena.

Understanding how acupuncture, combined with key herbal and nutrient medicines, can modulate brain activity and restore homeostatic plasticity to help stop the addictive cycle and achieve neurocognitive restoration

Much research has identified the key areas of the brain involved in the stages of the addiction cycle. These include the nucleus accumbens, the prefrontal cortex, the amygdala, the hippocampus, the limbic cortex, and the hypothalamus. Mapping of the brain function has clearly shown the capacity for acupuncture and electroacupuncture to affect and modulate these key areas with specific points and specific types of stimulation. While this neural modulation by itself will not solve all cases of addiction, there is clear evidence that it will greatly add to the success of the holistic treatment outcome.

In 2014, researchers at Brown University showed that long-term depression of two independent inputs from the prefrontal cortex to the nucleus accumbens are involved in the craving and behavioral response in cocaine addiction, with one input increasing the behavioral response while the other attenuates it, creating the prorelapse and antirelapse pathways. Such research clearly shows that modulation of these pathways, not simple inhibition or heightening, is needed to correct addction (PMID: 2523302). A number of research studies have shown that specific acupuncture and electroacupuncture stimulations modulate these responses, as well as the key biochemical responses seen in addiction, such as FosB expression, which is involved in homeostatic neuroplasticity and overexpressed in all types of addiction in the nucleus accumbens. Since delta FosB expression is linked to resilience to stress and induced by various types of social stress, as well as induced in the reward mechanisms associated with addictions, simply blocking expression of the FosB protein would solve the problem of addiction, and would be detrimental to the handling of stress. Treatment that encourages healthy homeostatic neuroplasticity will result in a healthy and measurable decrease in FosB expression in the nucleus accumbens during the addiction cycle, and research documented below in Additional Information shows that acupuncture and electroacupuncture achieve this goal. FosB expression is also linked to the expression of sirtuins, another class of signaling proteins linked to modulation of stress resistance, inflammation and aging.

A well-studied Chinese herbal chemical, resveratrol, is now well known in its ability to modulate sirtuins, encouraging more activation of SIRT1 to provide a better balance in sirtuin effects. Studies at the University of Texas Southwestern Medical Center in 2010 found that a balance of sirtuin expression in the nucleus accumbens was a key factor in explaining how cocaine induced or controlled addictive behavioral effects, especially in regards to stress stimuli. While this study demonstrated the potential role of chemical inhibitors of sirtuins to treat addiction, a more sensible protocol may be to help restore a balance of sirtuin effects. Studies now are refining the role of such herbal chemicals in the cycle of addiction. For instance, a 2013 study at Kurume University School of Medicine, in Fukuoka, Japan, found that resveratrol acutely enhances cocaine-induced dopamine neurotransmission and behavioral responses by inhibition of dopamine breakdown. While the use of resveratrol during some stages of addiction might be counterproductive, use of the herbal chemical during a period of withdrawal from the addictive drug would allow the patient to perhaps decrease dosage without suffering the craving effects induced by lowered dopamine stimulation. Dopaminergic herbs may also ease this craving for inducing the dopamine, or reward, response during drug, alcohol, or food withdrawal.

In 2011, experts at the Mudanjiang Medical University and the Medical College of Yanbian University, in China, and Daegu Haany University and the Medical school of Chanbuk National University, in South Korea, released the results of continuing study of the effects of specific acupuncture points in the treatment of addiction. In this follow-up study, the common points H7 and P6 attenuated anxiety in alcohol withdrawal syndrome, and the effects of dopamine normalization in the nucleus accumbens of laboratory animals was measured in a randomized controlled trial. Blood plasma CORT levels were also inhibited during alcohol withdrawal, and prior studies have shown the significant effects of this one point combination to significantly improve insomnia with anxiety (Evid-Based Compl and Alt Med Vol 2011 - 429843 / PMID: 25936591). Prior studies at the Daegu Haany University School of Medicine found that acupuncture at H7 bilaterally attenuated the decrease of dopamine release in the nucleus accumbens of animals experiencing alcohol withdrawal by modulating the GABA receptors A and B (PMID: 18680784). As more evidence accumulates, we see that a combination of short freqent courses of acupuncture with a more prolonged step-by-step protocol with herbal and nutrient medicine could play a significant role in treatment of the stages of addiction.

The evidence supporting Complementary Medicine in the form of short courses of acupuncture with herbal and nutrient medicine as part of a holistic protocol that is really needed to counteract the cycle of addiction is strong. Inclusion of an intelligent use of such therapeutics as Resveratrol, N-acetyl cysteine, L-glutamine, inositol hexacotinate, P5P, zinc monomethionine, benfotiamine, R-lipoic acid, Milk Thistle, dopaminergic herbs such as Uncaria, Kava, Mucuna pruriens, and Hypericum (St. John's Wort), and other herbs and formulas, provide the professional Complementary Medicine physician, such as the Licensed Acupuncturist and Herbalist, to design a step-by-step individualized therapeutic protocol to stop the cycle of addiction. Intelligent professional guidance and analysis is essential for success in this integrative protocol, and it is a complement to standard therapy, especially utilization of Cognitive and Behavioral Psychology. We can clearly see that simply taking a one-size-fits-all pill to curb addiction is not going to work. The person in charge of the cure must be the patient, and working with a Licensed Acupuncturist and Herbalist offers much help in this process. We also see that the business of addiction treatment has become very expensive, with many patients reporting that they spent over $60,000 on their treatment and had to exhaust their financial resources. This financial burden could be greatly reduced by early treatment intervention, a proactive approach, and the relatively inexpensive integration of Complementary Medicine.

Integration of Cognitive and Behavioral Therapy into the Complementary and Integrative Medical Approach with TCM

The field of Psychology and the Cognitive and Behavioral Therapy approach has gone from almost no training and utilization in the care of addiction to an important and growing aspect of the integrative treatment protocol. In Traditional Chinese Medicine this approach was discussed intensively even in the earliest complete texts of the Complementary and Integrative Medicine, such as the Huang Di de Nei Jing. Over the centuries in China the connection between the mind and body, and between specific emotions and visceral systems was much discussed. While this subject is daunting, we see some very practical aspects if we take these concepts seriously. For instance, in the cycle of Five Elements and the need to achieve a fluid balance of Yin and Yang, concepts that dominated Chinese thought for centuries, there is a natural explanation for emotional imbalance and constraint, not a simplified explanation, but a thoughtful one. Emotions were described as a very changing and quickly erratic phenomenon, described in elemental terms with metaphor as Wind, and constraint of the natural expression of emotions was considered a key factor in disease. Gaining a personal understanding of this autonomic system was important when our natural homeostatic balance was dysfunctional. Much could be done to correct and restore the natural cycle of emotional expression and control. Directly, we can see that specific emotions generate other emotions, control excess of these other emotions, and counter other specific emotions. The 5 Element cycle helps explain this system, and we see for instance that Anger may generate excitement and could control obsessive overthinking, or dwelling on an emotional subject. We also see in this model that a greater sense of Identity can exert a parental-like constraint on excess Anger, and that the emotion of Anger is often associated with sadness and depression. Anger can have a Yin and Yang aspect, and can be used to achieve healthy effects, spurring positive action and breaking one out of a depressive and sluggish state, but also can be excessive and lead to behavior seeking too much excitement or a high, and can be excessive and lead to over-control of our reasoning emotions. In elemental terms this is described as Wood generating Fire and controlling Earth, and as Water engendering and parenting Wood, which is associated with Wind, which of course is a foreign and strange set of concepts, but nevertheless was integral to concepts in healthcare for thousands of years traditionally, not only in China, but in European history. By looking at this cycle of emotional function one can start seeing what is going wrong and take steps to consciously correct this system of imbalances. Of course, TCM would caution that these emotional states can be erratic and confusing, like Wind, and one must realize this and adapt to unwanted emotional flares and changes.

These emotions and this cycle of emotions are linked in TCM to both visceral physical systems and to the corresponding meridians, or patterns of points. In this way, specific acupuncture point stimulations and specific herbs and herbal formulas, as well as specific dietary treatment, all could be integrated to achieve better outcomes. This is the complex and thoughtful practice of the medical specialty, and was meant to be integrated into the overall care of the patient. In modern times, this same system could be utilized effectively, and patients could take a proactive approach, seeking out understanding of their disease mechanisms, getting help with CBT and treatment from a TCM physician. This type of care could be utilized a little or a lot, and could be easily integrated with standard programs of addiction treatment. It is unlikely that any single type of addiction treatment will be successful if it does not address the complex cycle of dysfunction and the holistic mind-body pathology, and simple and specific treatment protocols that the patient believes may just relieve them from their addiction without a strong proactive participation have obviously failed. There is no magic bullet or pill that will resolve addiction, but more than half of patients with addiction find that over time the addictive state resolves, in a great majority of cases on its own, as the body corrects its health dysfunction as it is genetically programmed to do. What one needs to do is to help their mind and body with whatever protocols are practical, and CIM/TCM offers a longstanding integrative set of protocols to help achieve this important goal. Accepting and utilizing this therapy is the big challenge for patients, as standard medicine is still loathe to acknowledge CIM/TCM at all.